Sciatic nerve palsy after total knee arthroplasty, accompanied by motor power weakness and electromyographic evidence, is a rare occurrence. In a 78-year-old female, pneumatic tourniquet was used for 72 minutes, with a pressure of 300 mmHg. The time and pressure are generally accepted values. We noticed sciatic nerve palsy showing motor power weakness and electromyographic evidence. One year after the operation, she recovered full motor power, but complained about a tingling sensation below the knee. Given that the nerve injury after using tourniquet was due to neural ischemia, and since our patient had vascular circulation problems such as atrial fibrillation and clip insertion due to internal carotid artery aneurysm, our patient can be considered as a high-risk patient with weakness to neural ischemic damage, even with the use of conventional tourniquet. Therefore, surgeons should be cautious when using tourniquet in patients with vascular circulation problems.
Aged ; Aneurysm ; Arthroplasty, Replacement, Knee* ; Atrial Fibrillation ; Carotid Artery, Internal ; Female ; Humans ; Ischemia ; Knee ; Sciatic Nerve* ; Sciatic Neuropathy ; Sensation ; Surgeons ; Tourniquets

Surgery for pathologic hip fracture poses significant challenges regarding the fixation of fracture and management of the original tumor lesion. An extensive destruction of the femoral neck and intertrochanteric region by benign or malignant lesions complicated by a pathological fracture generally necessitates total hip arthroplasty; however, in adolescents and young adults, preservation of the hip is preferable. We present a 14-year-old female patient, who sustained a pathological intertrochanteric fracture through a pre-existing aneurysmal bone cyst. Several operative interventions with internal fixation and bone graft were unsuccessful, and combined nonunion and progression of osteolysis around the compression hip screw eventually caused femoral head collapse, mimicking osteonecrosis. Hip preservation and resolution of the original tumor were achieved by free vascularized fibular graft.
Adolescent ; Aneurysm ; Arthroplasty, Replacement, Hip ; Bone Cysts ; Female ; Femur Neck ; Fractures, Spontaneous ; Head* ; Hip ; Humans ; Osteolysis ; Osteonecrosis ; Transplants* ; Young Adult

PURPOSE: The purpose of this study was to evaluate the sustainability and adverse effects of ultrasound-guided selective nerve root block in patients who complained of radiculopathy due to lower cervical disc herniation. MATERIALS AND METHODS: Between February 2014 and February 2016, 39 out of 60 patients who visited Department of Orthopedic Surgery, Kosin University Gospel Hospital with a chief complaint of radiculopathy due to lower cervical disc herniation were treated with an ultrasound-guided selective nerve root block. To evaluate the efficacy and sustainability of this treatment, the degree of pain relief and functional improvement were evaluated before and 3 months after the procedure. Patients were categorized into two groups: The soft disc group and the hard disc group. The safety of the procedure was evaluated by examining the side effects occurring immediately after the procedure and the following day. RESULTS: Visual analogue scale and Neck Disability Index were improved from 6.00 to 3.02 and from 15.82 to 6.15, respectively (p < 0.05). There were 2 cases of headache and 2 cases of dizziness; however, they were resolved within 1 hour after the procedure. In 32 patients (82.1%), there was improvement in pain, which persisted for more than 3 months in 24 patients. Contrastinly, 7 patients (17.9%) showed no improvement and 6 patients (15.4%) experienced recurrence of pain or symptoms within 1 month after the procedure. In the soft disc group, there was a reduction in pain, from a score of 5.88 before the procedure to 2.64 twelve weeks after the procedure (p < 0.01). In the hard disc group, there was also a reduction in, from a score of 6.09 before the procedure to 3.22 at postoperative 12 weeks (p < 0.01). There was no significant difference between the two groups. CONCLUSION: In patients with cervical disc herniation, an ultrasound-guided selective nerve root block appears to be an effective treatment option for outpatients due to its low risk of serious complications.
Dizziness ; Headache ; Humans ; Intervertebral Disc Displacement ; Neck ; Nerve Block ; Orthopedics ; Outpatients ; Radiculopathy ; Recurrence ; Spine* ; Ultrasonography

PURPOSE: Hemicortical resection may be applied to bone tumors arising at the bone surface or of eccentric location due to minimal medullary involvement. The purpose of this study was to evaluate the results of hemicortical resection for malignant bone tumors. MATERIALS AND METHODS: We retrospectively reviewed 18 patients who were treated with hemicortical resection between 2005 and 2014. The study included 10 patients with parosteal osteosarcoma, 5 patients with osteosarcoma, 2 patients with periosteal chondrosarcoma, and 1 patient with chondrosarcoma, who were followed-up for a mean duration of 61 months (24–125 months). We evaluated 1) the oncologic outcome (recurrence, metastasis), 2) the rate of bony union, and 3) complications, such as fracture or infection, after hemicortical resection and reconstruction. RESULTS: There were local recurrences in 3 parosteal osteosarcoma patients (16.7%). After subsequent re-excision for recurrence, one patient died of metastasis. The defect after hemicortical resection was reconstructed by bone graft in 15 patients and the grafts were removed for infection in 2 patients. Bone grafts were united in 12 (92.3%) out of 13 patients at 8 months (5–13 months) after reconstruction on average. Host bone fractures occurred in 2 patients (11.1%); infection developed in 3 patients (16.7%), who received hemicondylar resection for osteosarcoma in proximal tibia. CONCLUSION: Hemicortical resection for eccentric tumors or small tumors showed good clinical results. There is relatively a high risk of infection in the lesion of proximal tibia.
Chondrosarcoma ; Fractures, Bone ; Humans ; Neoplasm Metastasis ; Osteosarcoma ; Recurrence ; Retrospective Studies ; Tibia ; Transplants

There have been many studies regarding the relationship between long-term use of bisphosphonate and atypical femoral fractures in the literature. However, studies regarding atypical fractures of the upper limbs are severely limited, especially in Korea. Here, we report an atypical fracture of the ulna in a patient with bisphosphonate medication for a relatively short period of 3 years without any history of fractures at other sites.
Femoral Fractures ; Humans ; Korea ; Osteoporosis ; Ulna* ; Upper Extremity

Parosteal lipoma is a benign tumor of the mature adipose tissue that contacts the periosteum of the underlying bone directly. The tumor commonly arises in the long bones, such as the femur, radius or tibia, and often exhibits underlying osseous changes, such as a cortical hyperostosis or erosion. Parosteal lipoma arising in a finger is rare. Furthermore, there are no reports of parosteal lipoma associated with underlying bizarre parosteal osteochondromatous proliferation. The authors present a rare case of parosteal lipoma of the proximal phalanx of the little finger accompanied by recurrent bizarre paroteal osteochondromatous proliferation in a 64-year-old male patient who had previously undergone an excisional biopsy at the same location 8 years earlier.
Adipose Tissue ; Biopsy ; Femur ; Fingers ; Hand* ; Humans ; Hyperostosis ; Lipoma* ; Male ; Middle Aged ; Periosteum ; Radius ; Tibia

PURPOSE: We evaluated the results of allograft reconstruction following wide resection of malignant bone tumors in long bone, retrospectively. MATERIALS AND METHODS: Seven patients were included. The mean age was 44 years old. Male was 4 cases, and female was 3 cases. Mean follow-up period was 38 months. The mean Musculoskeletal Tumor Society (MSTS) score at final follow-up was evaluated. Postoperative complications were evaluated via periodic radiologic follow-up. Oncologic results were analyzed at final follow-up. RESULTS: The primary malignancies occurred at femur in 5 cases, humerus in 1 case and tibia in 1 case. Pathologic diagnoses were osteosarcoma in 4 cases, multiple myeloma in 2 cases and adamantinoma in 1 case. Mean length of allograft was 165 mm. Fixations of allograft were intramedullary nailing with additional plate in 4 cases, intramedullary nailing in 2 cases, and screw fixation in 1 case. Mean time to union was 14.5 weeks. Mean MSTS score at final follow-up was 20 (67%). Postoperative complications were nonunion in 3 cases, implant failure in 1 case, and infection in 1 case. Oncologic outcomes were continuous disease free in 5 cases and alive with disease in 2 cases at final follow-up. Autologous bone graft and hemi-cortical onlay graft were performed in 2 cases of nonunion. CONCLUSION: Allograft reconstruction following wide resection of malignant bone tumors in long bone was effective surgical option. However, the possibility of nonunion between host bone and allograft should be considered.
Adamantinoma ; Allografts* ; Diagnosis ; Female ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Humerus ; Inlays ; Male ; Multiple Myeloma ; Osteosarcoma ; Postoperative Complications ; Retrospective Studies ; Tibia ; Transplants

PURPOSE: Extensor carpi ulnaris (ECU) subluxation has a low incidence rate, to date, there has only been a few studies evaluating the operative treatment for type of injury. The purpose of this study was to retrospectively analyze 11 patients with ECU subluxation who underwent operative treatment. MATERIALS AND METHODS: Between March 2005 and February 2015, 11 patients received operative treatment. Magnetic resonance imaging and dynamic ultrasound were used to make the diagnosis. ECU subluxation patterns were classified by the Inoue's classification system. There were two cases of type A, one case of type B, five cases of type C, and three cases unfit for Inoue's classification. We also found two cases of radial subluxation and one case of ulnar locked subluxation. In type A and B cases, ECU tendons were relocated then sheaths repair was performed, and the extensor retinaculum reconstruction was performed. In type C cases, the fibro-osseous sheaths were fixed. In the three unclassified cases, extensor retinaculum reconstruction was performed. In all cases, fibro-osseous sheaths were fixed using the anchor suture technique. We compared the clinical results based on the following: motion range of the wrist joint; grip strength; visual analogue scale (VAS) score; quick disabilities of the arm, shoulder and hand (Q-DASH) score; and Mayo wrist score. RESULTS: The median age of patients at the time of the operation was 32 years, and the average follow-up period was 11.2 months. There were five cases of triangular fibrocartilage complex tear, two cases of distal radioulnar joint instability, three cases of ECU split tear as accompanying injury. There were significant differences in the clinical results. The average motion range of the wrist increased compared with the preoperative value (84.7% to 92.4% compared to contralateral normal side). The postoperative VAS score, Q-DASH score and Mayo wrist score showed better results compared with the respective preoperative values (6.0 to 1.1, 40.9 to 12.4, 75.9 to 86.4). CONCLUSION: ECU subluxation is a rare occurrence. Dynamic ultrasound is useful in diagnosing ECU tendon subluxation. Satisfactory results can be obtained with the use of a proper technique, which depends on the type of subluxation.
Arm ; Classification ; Diagnosis ; Dislocations* ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Incidence ; Joint Instability ; Magnetic Resonance Imaging ; Retrospective Studies ; Shoulder ; Suture Techniques ; Tears ; Tendons* ; Triangular Fibrocartilage ; Ultrasonography ; Wrist ; Wrist Joint

PURPOSE: There have only been a few studies on optimal usage of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine. MATERIALS AND METHODS: A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a Chungnam National University Hospital between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5%, 44 ml), group B (0.6%, 30 ml), and group C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain, and postoperative pain were evaluated using a visual analogue scale (VAS) score. Patient's satisfaction (0–10) was investigated. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively. RESULTS: There were 108, 118, and 113, in groups A, B, and C, respectively; and there were no significant differences with respect to the number, age, sex, and type of operation (p>0.05). The mean complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The mean intraoperative VAS scores were 2.04, 0.62, and 0.24; and the mean postoperative VAS scores (6 hours/12 hours) were 2.41/4.08, 0.27/1.24, and 0.38/1.54. The mean patient's satisfactory scores were 8.53, 9.38, and 9.40, respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p < 0.05) and higher intra, postoperative VAS scores (all p < 0.05). Group B showed longer complete anesthetic time (p < 0.05), but no significant difference of intra, postoperative VAS scores (all p>0.05). Patient's satisfactory scores in both group A and B were similar to group C (p>0.05, p>0.05). There were no specific adverse reactions in all groups. CONCLUSION: Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.
Anesthetics ; Chungcheongnam-do ; Femoral Nerve ; Humans ; Lower Extremity* ; Nerve Block* ; Pain, Postoperative ; Prospective Studies* ; Sciatic Nerve ; Ultrasonography

PURPOSE: Peripheral nerve block is one of the many options available to reduce pain after total knee arthroplasty. Among the various kinds of peripheral nerve block procedure, femoral nerve block (FNB) using ropivacaine is a very effective method for reducing pain. However, it has been known to cause weakness in the quadriceps femoris, resulting in an increased risk of fall during ambulation after surgery. The purpose of this study was to compare the effectiveness of FNB on pain and muscle strength with different concentrations of ropivacaine. MATERIALS AND METHODS: Our study was performed on 120 patients with knee osteoarthritis who had undergone total knee arthroplasty between January 2016 and December 2016. Patients were divided to 3 groups depending on the concentration of ropivacaine: Group 1 received 0.125% ropivacaine 6 ml FNB; group 2 received 0.2% ropivacaine 6 ml FNB; group 3 received normal saline 6 ml FNB. FNB with 1% lidocaine 10 ml and 0.75% ropivacaine 10 ml was performed to all groups at 3 hours after surgery. From the day after surgery, each group of patients were injected 4 times with FNB on their own designated concentration of ropivacaine with an interval of 6 hours. The severity of pain was estimated by visual analogue scale (VAS) and the strength of quadriceps femoris was measured using medical research council (MRC) grade and knee extension angle. RESULTS: VAS score in group 3 was significantly higher compared to other groups; MRC grade in group 2 was significantly lower than in other grades, and knee extension angle in group 2 was significantly lower than in other groups at 6 pm on the day of and at 6 am on the day after surgery. VAS score, MRC grade, and extension angle of all groups showed no significantly difference at other times. CONCLUSION: FNB with 0.125% ropivacaine after total knee arthroplasty shows effective reduction of pain without inducing quadriceps femoris weakness.
Arthroplasty, Replacement, Knee* ; Femoral Nerve* ; Humans ; Knee ; Lidocaine ; Methods ; Muscle Strength ; Osteoarthritis, Knee ; Peripheral Nerves ; Quadriceps Muscle ; Walking